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Report: U.S. hospitals face diminished reserves, mounting reimbursement challenges
Payment denials by Medicare Advantage plans jumped 56% for the median health system between January 2022 and June 2023, contributing to a 28% decline in median cash reserves, according to the latest analysis of data from over 1,300 hospitals and health systems by Syntellis Performance Solutions and the AHA.
AHA Urges CMS to Swiftly Correct Medicare Advantage Plan Policies That Appear to Violate CY 2024 Rule
The American Hospital Association is deeply concerned that these practices will result in the maintenance of the status quo where MAOs apply their own coverage criteria that is more restrictive than Traditional Medicare proliferating the very behavior that CMS sought to address in the final rule, resulting in inappropriate denials of medically necessary care and disparities in coverage between beneficiaries in MA and those in the Traditional Medicare program.
AHA urges CMS to swiftly correct MA plan policies that appear to violate CY 2024 rule
Certain Medicare Advantage organizations have issued policies for the coming year that AHA believes do not fully adhere to requirements in the MA final rule for calendar year 2024, the association alerted the Centers for Medicare & Medicaid Services Nov. 20.
AHA Urges MedPAC to Examine Medicare Advantage Denials, Hospital Market Basket
We appreciate the Medicare Payment Advisory Commission’s (MedPAC) November meeting discussions on Medicare Advantage (MA) prior authorization and network management. As MedPAC begins its discussions on payment adequacy for the Medicare program, we outline concerns about the impact that the shifting labor force and costs have had on hospitals and health systems, including whether the current market basket methodology is adequate to capture these changes.
Senators call for CMS to increase MA plan oversight, reporting requirements
The Centers for Medicare & Medicaid Services should require Medicare Advantage plans to submit additional data and the agency should publicly release the MA data it already collects, a bipartisan group of senators told the agency last week.
CMS warns MA, Part D plans and PBMs to comply with new access requirements
The Centers for Medicare & Medicaid Services will closely monitor Medicare Advantage and Part D plans for compliance with new requirements effective Jan. 1 to ensure timely access to care, medications and vaccinations, the agency warned plans and pharmacy benefit managers Dec. 14.
AHA Comments on CMS’ Proposed Medicare Advantage Policies for 2025
AHA comments on the CMS proposed rule for policy and technical changes to the Medicare Advantage program in contract year 2025.
AHA comments on proposed Medicare Advantage policies for 2025
AHA Jan. 5 voiced strong support for Centers for Medicare & Medicaid Services proposals to increase oversight and enhance consumer protections in the Medicare Advantage program for contract year 2025.
UnitedHealthcare clarifies new hospital services review process for Medicare Advantage plans
UnitedHealthcare has released a FAQ to clarify its hospital services review process for Medicare Advantage products effective Jan. 1, 2024 under the calendar year 2024 Medicare Advantage final rule.
Protecting Patient Care with Enhanced Medicare Advantage Oversight and Prior Authorization Changes
For many people, choosing an MA plan is a life-changing event and a significant act of trust, counting on the payer they selected to provide the pre-agreed upon coverage for either current medical needs or those that may arise.